Acknowledgements This report was developed by representatives from the Chin State Health Department, Central MoHS Department of Public Health, Central MoHS Department of Medical Services, National Health Plan Implementation Monitoring Unit (NIMU) from the Ministry of Health and Sports, and the Three Millennium Development Goal Fund (3MDG). The team responsible for the Chin Health Report 2018 would like to thank the Chin State Health Director and Deputy Chin State Health Director, and representatives from State Health Departments for their guidance and contribution to the development of this report. Special thanks goes to all the Township Medical Officers and Basic Health Staffs from all the nine townships of Chin State for their cooperation and profound contribution to data gathering and coordination at township level. The team´s gratitude also goes to the State Government, Implementing Partners (INGOs, UN agencies, Civil Society Organizations) and donors for providing valuable inputs. Lastly, the team would like to thank all partners that have provided financial as well as technical support throughout the whole process. National Health Plan Implementation Monitoring Unit (NIMU) NIMU is a dedicated unit under the Minister’s Office, Ministry of Health and Sports Myanmar (MoHS). NIMU coordinates and facilitates the execution of activities included in the National Health Plan (2017-2021) and Annual Operational Plans together with all the Departments of MoHS, MOHS at various levels, and key stakeholders. The Three Millennium Development Goal Fund (3MDG Fund) The 3MDG Fund is a multi-donor trust fund funded by Sweden, Switzerland, United Kingdom, and USA, and operated by United Nations Office for Project Services (UNOPS). Together with the Government of Myanmar and other partners, the 3MDG Fund improves maternal, newborn and child health, help combat HIV and AIDS, tuberculosis and malaria, and support health system strengthening. Chin State Health Report 2018 Author © 2018 The National Health Plan Implementation Monitoring Unit, The Ministry of Health and Sports, Myanmar Authors: Ye Min Htwe, Bawi Mang Lian, Wai Yee Khine Editor: Nina Margareta Hoie, Thet Aung, Bawi Mang Lian Contributors: Chin State Public Health Department, Divisions under Department of Public Health and Department of Medical Services, NIMU and 3MDG Fund All rights reserved. The use of any part of this publication in any form reproduced, ransmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, or stored in a retrieval system, without the prior written consent of the publisher is an infringement of the copyright law. Requests for permission to reproduce or translate NIMU publications – whether for sale or for noncommercial distribution – should be addressed to NIMU Office, at the Office (4), Zeya Htani Road, Nay Pyi Taw, Myanmar (tel: +95 67 3411506, fax: +95 67 3411506, e-mail: [email protected]). NIMU is a dedicated unit under the Minister’s Office, Ministry of Health and Sports Myanmar (MOHS). NIMU coordinates and facilitates the execution of activities included in the National Health Plan (2017-2021) together with all the Departments of MOHS, MOHS at various levels, and key stakeholders. 2 Chin State Health Report 2018 Table of Contents Foreward 4 Process of Report Development 5 Acronymes 6 Executive Summary 7 1.0 Introduction 9 1.1 Universal Health Coverage 9 1.2 The National Health Plan: Myanmar’s Path to UHC by 2030 10 2.0 Chin State: Demographic and Socio-Economic Characteristics 13 3.0 Situation Analysis: Health Needs in Chin State 15 3.1 Leading Causes of Morbidity and Mortality in Chin State 16 4.0 Situation analysis: Health System in Chin State 17 4.1 Human Resources for Health 17 4.2 Infrastructure 20 4.2.1 Distribution 20 4.2.2 Standard Design 23 4.2.3 Staff Housing 23 4.5 Medicines and Equipment 24 4.6 Health Information System 24 4.7 Health Service Utilization and Hospital Occupancy 25 5.0 Identified Priority Health Problems in Chin State (2017) for 2018 29 5.1 Under-Five Mortality 29 5.2 Malnutrition 31 5.3 Malaria 32 6.0 Problem Trees and Problem Solving 33 6.1 Under-Five Mortality 33 6.2 Malnutrition 36 6.3 Malaria 39 7.0 Infrastructure Plan for FY 2018-2019 43 8.0 Health System Strengthening Priorities (short-/medium-/long-term) 44 9.0 Conclusion 48 10. Annex 49 3 Chin State Health Report 2018 Foreward Chin State has the highest maternal mortality ratio in the country, malaria prevalence is exponentially higher than national average in certain townships, and as much as 41 percent of children under-five are stunted.1 The population is extremely poor, and its geographical location makes many places hard to reach and prone to natural disasters like flooding and landslides. Decades of underinvestment in health have led to poor health outcome for many of the country's most vulnerable populations, including those residing in Chin State. With the framework presented in the National Health Plan 2017-2021 (NHP), things are about to change: Myanmar is committed to achieve universal health coverage (UHC) by 2030. This means that everyone can access needed quality health services without suffering from financial hardship as a result. Realizing the goal of UHC does not only contribute to better overall health for the population, it also supports sustainable economic growth and helps building stronger communities. For the successful implementation of the NHP, the Ministry of Health and Sports are prioritizing bottom-up planning and budgeting at State/Region and Township level that is inclusive of all relevant stakeholders. This is essential for reducing overlapping or duplication in health service delivery, which is the key to efficient and effective utilization of the health budget. The Chin State Health Report 2018 is one of the three state health reports which will work as a template for how to plan, structure and implement inclusive state and township health plans nationwide. The plan is an important first step to ensure access to primary healthcare and for making UHC a reality in Myanmar. Sincerely, Pau Lun Min Thang Minister of Social Affairs, Chin State Government 1 Government of the Union of Myanmar, Ministry of Immigration and Population. The 2014 Population and Housing Census, URL: http:// countryoffice.unfpa.org/myanmar/census/ 4 Chin State Health Report 2018 Process of Report Development In late 2017 and 2018, State Health Departments and key partners working at state and township level in Shan North, Chin State and Kayah State participated in several planning and budgeting meetings organized by State Health Departments in collaboration with the central Ministry of Health and Sports (MoHS). At the time of this report writing, a series of workshops have been conducted. The first workshop was held in Shan North in November 2017, the second and third workshop in Kayah State in early and late January 2018, the fourth and fifth workshop in Chin State in March 2018 and April 2018. The finalization workshop for Kayah State was conducted in July 2018. The objectives for these workshops were to: 1) to get a better understanding of the state/region and township challenges related to planning and budgeting, 2) to explore methodologies for planning and budgeting, 3) to share best practices, and 4) to develop national guidelines for State/Regions that are inclusiv of State/Region specific data and information. These workshops also gave the MoHS an opportunity to share the national policies and strategies, including the National Health Plan Universal Health Coverage goal, as well as specific disease program strategies. All key stakeholder groups were invited to attend the above-mentioned state health planning and coordination workshops. The NHP recognizes the variety of providers that are delivering health services including Ethnic Health Organizations (EHOs) and Non-Governmental Organizations (NGOs), Civil Society Organizations (CSOs), Professional Associations and the private sector. Furthermore, the local State Government and Parliamentarians were actively engaged to ensure State-level ownership and leadership. Crucial to the inclusive planning and budgeting process is the development of national, standard planning and budgeting templates and guidelines. These will be rolled-out nationwide to inform the involved stakeholders of the tools, guidelines and processes. The process of the Chin Health Report 2018 will inform the development of a national, standard planning and budgeting template and guidelines - including situation analysis, planning, costing and budgeting, as well as the important roles of different stakeholders in ensuring the successful implementation of the developed plans. 5 Chin State Health Report 2018 Acronymes 3MDG The Three Millennium Development Goal Fund ACT Artemisinin-based combination therapy AMW Auxiliary Midwife ANC Antenatal Care ARI Acute respiratory infection BHS Basic Health Staff Basic EPHS Basic Essential Package of Health Services CDK Clean delivery kit CHW Community Health Worker CSO Civil Society Organization COL Cirrhosis of Liver DMO District Medical Officer DP Development Partner EHO Ethnic Health Organization HTR Hard to reach IEC Information, Education and Communications INGO International Non-governmental organization LIFT Livelihoods and Food Security Trust Fund LLITN Long-Lasting Insecticide-Treated Net MoPF Ministry of Planning and Finance MoHS Ministry of Health and Sports MPLCS Myanmar Poverty and Living Conditions Survey NGO Non-governmental organization